b'Implement Company Policies with Ease Record and Communicate Payroll ChangesComplyRightSeparation NoticeEmployee InformationSeparation Notice Name ______________________________________________________________________________________________________ Employee/Payroll ID # ______________________Position _____________________________________________________________________________ Department_____________________________________________________ Satisfy the documentation needed when an Supervisor_______________________________________________________________________________________________________________________________________________________________________________/ / / / / /employee resigns, is terminated or laid off, Hire Date_________________________ Last Date Worked_________________________ Effective Separation Date _____________________Details of Separationor retires. Fill-and-SaveTM format simplifies Type of Separation: ResignationLayoffTerminationJob abandonmentthe process of routing, completing andOther___________________________________________________________________________________________________________________________________Reason for Separation:storing the form.PersonalOther EmploymentRelocationRetirementConductAttendancePerformance Reduction/ReorganizationOther_________________________________________________________________________________________________Checklist details critical discussion points Final Pay:Yes NoAmount$_____________________________________________Regular Pay Accrued Vacation Pay Yes NoAmount$_____________________________________________Ideal for both on-site and remote workers Accrued Sick Pay Yes NoAmount$_____________________________________________Other Yes NoAmount$_____________________________________________/ /Item # Price Date Payable _____________________ Total Payable Amount$_____________________________________________Separation Meeting:LD1-A0373CFL$27.95 Was there a separation meeting?YesNoMeeting Date ____________________ Location ______________________________________/ /Attended by____________________________________________________________________________________________________________________________________Administrative ChecklistCompany Materials/Equipment ReturnedFacility/Systems Access TerminatedInsurance Companies Notified:Company Policies Smart App Fill-and-Save item Employee Records ArchivedFinal Pay Processed HealthMajor Medical & MedicalCOBRA Notification Processed401(k) 403(b) Option Processed LifeLife Insurance ConversionPayroll Adjustment Forms Processed DentalAccess 100+ mandatory, recommended and optional policies including specificsMail/Pickup Last PaycheckOther ________________________________________for your state. Choose the attorney-approved policies you want to implement,Item #Price Other ________________________________________/ /edit as needed to fit your companys culture, and create a policy handbookCompleted by ________________________________________________________________________________________________ Date ___________________________LD1-SA900$129 per yearwith ease. Issue policies to individuals or the entire staff and, with automatedThis product is designed to provide accurate and authoritative information. However, ith i st hneo tu an dseurbssttaitnudtien gfo trh laetg aanl ayd pveicreso ann od rd eonetsi tny ot provided l eing acrl eoaptiinnigo,n psr oond uacniyn gs poerc difisict rfaibcutsti nogrstheirsv picreosd. uTchte i sin nfoort mliaabtiloe nf oisrapnroyv didaemda wgeits a anryis sinpge coiufictoqfu tehset iuosnesoorricnoanbcileitryn sto y ouuse m thaiyshave.A Im lv uecat.n Yt onuo ater:e T uhrigs eisdatop pcroonvseudl tf oanruasteto bryn ethy ec opnucrechrnaisnegryoonulyr . pTahritsi cfoulramrsmitauya tnioontbaen dshared publicly or with third parties.02307232 CCFoLmplyRight, Inc. inrvop odortptracking, see at a glance when employees have viewed each policy.Web BasedPayroll/Status Change NoticeLearn more at hrdirect.com/smartapps Employee InformationEffective Date of Change__________________________ Available in/ /Name________________________________________________________________________________Employee/Payroll # ______________________________Status: Full-Time Part-Time Full-Time Temporary Part-Time TemporaryFill-and-SavePosition _______________________________________________ Salary Hourly Department_____________________________________ Other___________________________Change(s) for Current Employee format or as part of the ComplyRightTypeFromTime & AttendanceAddress ChangePayroll/Status Change Notice To Payroll Forms ___________________________________________________________________________________________________________Payroll/Status Change NoticeChange of Insurance ___________________________________________________________________________________________________________ DemotionPlease PrintPayroll___________________Form Library ___________________________________________________________________________________________________________ DepartmentRouting___________________NEW HR Policies LibraryEnd of Introductory PeriodPlease PrintPayroll//______________________________________ Separation Document all job and salary changes, including___________________________________________________________________________________________________________ FLSA Reclassification ___________________________________________________________________________________________________________ Middle .Separation Insurance EligibilityEffective Date of Change _____________New Hire on page 9Routing Change ___________________________________________________________________________________________________________Employee Name_____________________________________________________________________________________________//Effective Date of ChangeLast _____________ First New Hire Change___________________________________________________________________________________________________________ Job TitleSocial Security # _____________________________ Employee/Payroll # ____________Dept. _____________________________ reclassification, transfers and promotions. List newEmployee Name_____________________________________________________________________________________________ ___________________________________________________________________________________________________________Subscribe to a library of HR policies developed and maintainedLength of Service Increase ___________________________________________________________________________________________________________ MiddleLastFirst Social Security # _____________________________Employee/Payroll # ____________Dept. _____________________________ Merit Increase ___________________________________________________________________________________________________________Address____________________________________________________________________________________________________ Promotion ___________________________________________________________________________________________________________ State/ / ZIP Code hire information, leave of absence and separationStreetCity by a team of HR experts and labor law attorneys. Select your state Salary/WageTelephone # _______________________________ Date of Birth (for administrative use only) __________________() StreetCityStateZIP CodeAddress____________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Shift ChangeStatus:Full-TimePart-TimeFull-Time Temporary Date of Birth (for administrative use only) __________________/ / ___________________________________________________________________________________________________________ Other______________________Telephone #_______________________________ Part-Time Temporary () Transfer ___________________________________________________________________________________________________________ Other______________________data. Ensure employee files have updated, current Job Title _______________________________ Exempt Non-ExemptW-4 Attached? Yes NoPart-Time TemporaryHourly and get 12 months of unlimited access to a collection of required Union ScaleStatus:Full-TimePart-TimeFull-Time TemporaryHourlyW-4 Attached? Yes No ___________________________________________________________________________________________________________Other _________________________ Change(s) for Current EmployeeExempt Non-Exempt Job Title __________________________________________________________________________________________________________________________________________ Change(s) for Current Employee FromToComments payroll records.Type and recommended policies (minimum of 50 state-specific policies). Comments____________________________________________________________________________________________________________________________________CommentsAddress Change _____________________________________________________________________________________________TypeFromToemotion _____________________________________________________________________________________________D Address Change ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Department Leave of AbsenceDemotion ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Choose the policies you opt to use and hide the ones you dont.Department _____________________________________________________________________________________________FLSA Reclassification _____________________________________________________________________________________________FLSA Reclassification _____________________________________________________________________________________________ Carbonless form instantly provides copies for401(k)/403(b) Contribution _____________________________________________________________________________________________ Insurance Eligibility _____________________________________________________________________________________________ // //Begin Leave______________________Return from Leave______________________401(k)/403(b) Contribution _____________________________________________________________________________________________Policies can be routed electronically, printed or cut and pastedEducational J ob Title _____________________________________________________________________________________________ Insurance Eligibility _____________________________________________________________________________________________Personal Family/Medical Leave (including Pregnancy)Short-Term DisabilityJof Insurance _____________________________________________________________________________________________ the employee, supervisor and HRs personnel filesChange _____________________________________________________________________________________________ Long-Term Disability Other_______________________________________ ob Title _____________________________________________________________________________________________Layoff _____________________________________________________________________________________________Change of Insuranceinto an existing handbook.Separation//of Service Increase _____________________________________________________________________________________________Separation Date ______________________ // //Length off Last Day Worked______________________Last Day Paid________________________Lay of Service Increase _____________________________________________________________________________________________Involuntary Separation_____________________________________________________________________________________________// Voluntary Separation erit Increase_____________________________________________________________________________________________M LengthNotice of COBRA Rights Provided on_________________________Election of COBRA YesNoMerit Increase_____________________________________________________________________________________________ Includes a ComplyRight guide to help you End of Introductory Period _____________________________________________________________________________________________//Start Date of Coverage______________________End of Introductory Period _____________________________________________________________________________________________Promotion _____________________________________________________________________________________________If yes, describe type of coverage elected:_________________________________________________________________________________________________eevaluation of Current Job _____________________________________________________________________________________________R Promotion _____________________________________________________________________________________________Categories cover a wide range of subjects from benefits Authorizations ehire _____________________________________________________________________________________________ document job and salary changes the right way_____________________________________________________________________________________________R Reevaluation of Current Job _____________________________________________________________________________________________Resignation _____________________________________________________________________________________________Rehire _____________________________________________________________________________________________Employee Signature (optional)______________________________________________________________________________//Date_____________________ Retirement _____________________________________________________________________________________________ Resignation _____________________________________________________________________________________________and compliance to conduct, safety and company propertySupervisor/Manager Signature_____________________________________________________________________________ Date_____________________alary/Wage _____________________________________________________________________________________________S Retirement _____________________________________________________________________________________________eparation //S Salary/Wage __________________________________________________________________________________________________________________________________________________________________________________________Human Resources/Payroll Manager Signature_____________________________________________________________// DescriptionItem #PriceS Separation Date_____________________hift Change __________________________________________________________________________________________________________________________________________________________________________________________T Shift Change _____________________________________________________________________________________________ ransfer _____________________________________________________________________________________________ Policies are Microsoft Word documents that can benion Scale _____________________________________________________________________________________________ U Transfer _____________________________________________________________________________________________Routing: Other ______________ _____________________________________________________________________________________________ Payroll/Status Change Notice Union Scale Payroll ____________________________________________________ ____________________________________________________ Other ______________Leave of Absence / / / /personalized for your company EducationalBegin Leave______________ Return from Leave________________ Family/Medical Leave (Including Pregnancy)Leave of Absence Begin Leave______________ Return from Leave________________Personal/ // /This product is designed to provide accurate and authoritative information p. rHooviwdeevde wr, iitth i st he Other ______________________________ 3-Part CarbonlessLD1-A2168$92.95p Short-Term Disability PersonalFamily/Medical Leave(Including Pregnancy)Educational Long-Term Disability no tu an dsuebrssttaitnudtein fgo trh laetg aaln ayd pveicreso ann 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Other ______________________________Short-Term Disability Long-Term Disabilitys Ideal for both on-site and remote workers22107222C CFoLmplyRight, Inc. propdourtcatn. Yt onuo ater:e T uhrigs eisd a tpop croonvseudl tf oarnuasteto bryn ethy ec opnucrecrhnaisnegryoonulyr .p Tahritsi cfourlamrmay not be shared publicly or with third parties. / / Last Day Paid _______________ Standard FormLD1-A2172$56.95A Im Separation Separation Date _________________ Last Day Worked _________________ Last Day Paid/ // /Separation Separation Date/ / eparation_________________/ /Notice of _______________Involuntar/ /Voluntary Separation_________________ y S Last Day WorkedCOBRA Rights Provided on_____________/ /Voluntary Separation Involuntary SeparationNotice of COBRA Rights Provided on_____________/ /Election of COBRA YesNo Start Date of Coverage_______________/ /Election of COBRA YesNo Start Date of Coverage_______________/ /If yes, describe type of coverage elected:_____________________________________________________________________________ Fill-and-Save Format*LD1-A2172CFL$27.95Unlimited 24/7 web access for multiple users If yes, describe type of coverage elected: _____________________________________________________________________________Fill-and-Save Additional Comments ________________________________________________________________________________________________Additional Comments ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Price per pkg/50. Standard: 8" x 11".Guaranteed compliancepolicies are updated Employee Signature(Optional)_________________________________________________________________________Date ________________(Optional) Name and Title / /Employee Signature _________________________________________________________________________/ / *Fill-and-Save form varies slightly from paper version.Name and Title Date ________________Name and Title / /Supervisor/Designated Manager Signature_____________________________________________________________ Date ________________should federal or state requirements changeSupervisor/Designated Manager Signature_____________________________________________________________Date ________________Name and Title / // /Human Resources/Payroll Manager Signature ___________________________________________________________ Date ________________Name and Title / /Human Resources/Payroll Manager Signature ___________________________________________________________Date ________________Name and TitleThis product is desiogrnmeadt itoon p irso pvirdoev iadcecdu rwaitteh a tnhdeauuntdheorrsittaatnidvein ign ftohramt aantiyo npe. rHsoonw eovre ern, titi tiysinnovto alv seudb isnti tcurteea tfionrg l,e pgraol adducviicnegaonrd d idsotreisb nuotitn pgr othviids pe rleogdaulc ot pisin nioont lsi aobnl ea fnoyrsapneyc idfiacm faacgtessor services. The infaripsionrgt aonuttnoof tteh: eT uhsiesiosraipnpabroilviteydtfoo ru uses et hbiystphreo pduucrct.h Yaoseuraorne luy.r gTehdi st ofo cromn smualty a nno att btoe shared publicly or with third parties. obnlcee fronrs a ynou may haFill-and-Save itemIm This rpvriocdesu.c Tt hisediensfiogrnmedat tioon p riso vpir toov iudseed t hwiist hpr tohdeu ucnt.d Yeorsut aanrde iunrgg ethda tto a cnoyn psuerlts oannoartt eonrney concerning your particular situation and an n any speyc idfaicm faacgtessve.o de accurate and authoritative information. However, titi tiysninovto alv seudb isnti tcurteea tfoinr gl,e pgarol daducviicnegaonrd d disoterisb nuotiyn gs ptehciisf ipcr oqduuesctti ons or crney concerning your particular situation and any specific questions or concerns you may have.t provide legal opisin nioont lsi ao22012628 ComplyRight, Inc. arr isseionrgt aonuttnoof tteh:e T uhsiesiosraipnparboilvietyd for use by the purchaser only. This form may not be shared publicly or with third parties.Item # Price per State A 22102628 ComplyRight, Inc. Two easy ways to reorder: hrdirect.com800-999-9111ImpA Two easy ways to reorder: hrdirect.com800-999-9111LD1-A9050W$99 per year 3-Part Carbonless18 WORKPLACE MANAGEMENTPOLICIES & PAYROLL HRDIRECT.COM800.999.9111 19'